Background: Autologous fat grafting (AFG) is commonly used in breast reconstruction for volume restoration or contour correction. Our previous study demonstrated that standard decantation yields inferior volume retention compared to active wash and filtration (AWF) and low-pressure decantation (LPS). Building upon these findings, we replaced standard decantation with a new processing technique, active wash with surfactant (AWFS). This study aims to evaluate long-term volume retention among AWF, LPS, and AWFS.
Methods: A prospective, randomized controlled trial was conducted at our institution between 2023 and 2025. Thirty patients were randomized in a 1:1:1 ratio to receive fat grafting processed by either AWF, LPS, or AWFS. Three-dimensional scans of the upper torso were obtained preoperatively and at 3 months postoperatively. Breast volume was measured using Autodesk Meshmixer, and volume retention was calculated as a percentage of the initial grafted volume. Differences in volume retention across groups were analyzed using one-way ANOVA.
Results: The volume of fat injected during the procedure did not differ significantly between groups: 89.0 ± 56.0 cm 3 for AWF, 125.8 ± 68.9 cm 3 for LPS, and 127.5 ± 78.7 cm 3 for AWFS ( P =0.33). Average volume retention at 3 months was 55.3% ± 17.2% for AWF, 58.7% ± 17.8% for LPS, and 62.7% ± 15.7% for AWFS. No significant difference in volume retention was observed across groups ( P =0.52).
Conclusions: Although AWFS demonstrated the highest average volume retention, differences between techniques were not statistically significant. These findings suggest comparable long-term outcomes among the 3 processing methods.
Keywords: autologous fat grafting; breast reconstruction; fat graft retention.
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